Nation Shifts Away from Nursing Home Care

WASHINGTON–During the past two decades, the number of Americans
receiving nursing home care has declined significantly, according
to a new study.

Published by health care and human services firm The Lewin
Group, the study found that the drop was particularly noticeable
among the nation’s “oldest old,” those 85 and older.

Since 1999 there has been a decline of more than 8 percent in
the number of nursing home residents age 65 and older–from 1.44
million to 1.32 million. The nursing home use rate among the oldest
old dropped from 21.1 percent in 1985 to 13.9 percent in 2004.

“The implications for the future are significant,” said Lisa
Alecxih, the study’s author. “While future disability rates and
income levels among older adults are difficult to forecast, the
baby boomers could be expected to have preferences similar [to]
those of the current group of older adults. That is, they would
probably seek to avoid nursing home care if possible.”

According to the study, several factors likely contributed to
the decline:

• The over-65 group is healthier and wealthier. Less disability
  can mean fewer people in nursing homes, and higher income provides
  more choice and the ability to pay for care and services.
• Because of changes in Medicare reimbursement and other forces,
  nursing homes increasingly focus on post-acute rehabilitation. The
  median length of stay declined from 1.7 years to 1.3 years.
• Over the last decade, alternatives such as assisted living
  facilities have become more widely available. And more home-based
  services have become available through state Medicaid and general
  revenue programs.
• Many states have tried to reduce the number of Medicaid
  recipients in nursing homes by diverting them away at critical
  times, such as at the time of hospital discharge.

The study also points out policy initiatives and court decisions
that have played a role in the shift away from nursing homes,
including President Bush’s New Freedom Initiative, Congressional
Funds for Real Choice Systems Change and the National Family
Caregiver Support Program.

The baby boom generation that reaches age 65 in 2011 will
account for twice as many older adults in 2030 as there are today.
If the demand for nursing homes continues to decline at half the
rate of the past 20 years, there will be only 320,000 more nursing
home residents among the “oldest old” instead of 830,000 more, the
study projected.